Department of Pediatrics, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
Pediatr Res. 2010 Nov;68(5):435-9. doi: 10.1203/PDR.0b013e3181f2bd4d.
Cerebral perfusion and its relation with systemic circulation in extremely LBW (ELBW) infants in the early neonatal period are not well understood. The cerebral tissue oxygenation index (TOI) and cerebral fractional tissue oxygen extraction (FTOE) were monitored in stable 16 ELBW infants (GA <29 wk) using near-infrared spectroscopy (NIRS) at 3-6, 12, 18, 24, 36, 48, and 72 h after birth. The left ventricular end-systolic wall stress (ESWS), left ventricular ejection fraction (LVEF), left ventricular cardiac output (LVCO), and superior vena cava (SVC) flow were also measured simultaneously using echocardiography. The ESWS increased till 18 h and then decreased; LVEF, LVCO, and SVC flow decreased till 12 h and increased thereafter. The TOI decreased till 12 h and correlated with SVC flow; FTOE increased until 12 h and then decreased. These changes in variables of NIRS and echocardiographic measurements contrasted to changes in mean arterial blood pressure (MABP), which showed trends of continuous and gradual increase after birth. We conclude that even stable ELBW infants undergo evident transitional changes in cerebral oxygenation and perfusion in the early postnatal period, which may reflect changes in cardiac function and cardiac output.
在新生儿早期，极低出生体重儿（ELBW）的脑灌注及其与全身循环的关系尚不清楚。本研究使用近红外光谱（NIRS）监测了 16 名出生后 3-6、12、18、24、36、48 和 72 小时稳定的 ELBW 婴儿（GA<29 周）的脑氧合指数（TOI）和脑分组织氧摄取量（FTOE）。同时使用超声心动图测量左心室收缩末期壁应力（ESWS）、左心室射血分数（LVEF）、左心室心输出量（LVCO）和上腔静脉（SVC）流量。ESWS 增加到 18 小时后下降；LVEF、LVCO 和 SVC 流量在 12 小时下降后增加。TOI 下降到 12 小时并与 SVC 流量相关；FTOE 增加到 12 小时后下降。NIRS 和超声心动图测量的这些变量的变化与平均动脉压（MABP）的变化形成对比，MABP在出生后呈连续逐渐增加的趋势。我们得出结论，即使是稳定的 ELBW 婴儿，在出生后的早期阶段也会经历明显的脑氧合和灌注的过渡性变化，这可能反映了心脏功能和心输出量的变化。
